Pujol Farriols R, Bernet Vidal M, Castellsagué J, Esquius Soriguera J, Raguer Sanz E, Yetano Laguna V
Servicio de Medicina Interna y de Anatomía Patológica, Hospital General de Granollers, Barcelona.
An Med Interna. 1994 Aug;11(8):372-6.
In the past years, the number of hospital clinical autopsies have significantly decreased, with the risk of loosing some of the functions of this procedure, among which the evaluation of the diagnostic accuracy, which has been considered as a health care quality index, stands out. In this paper, the consistency between clinical diagnosis and autopsies in a general hospital is studied, as well as its association to some potentially relevant factors. We review 91 autopsies performed in patients dying in the Service of Internal Medicine during a period of six years. Each case was classified though consensus among a clinician and a pathologist into: mayor clinicopathological discrepancy, minor discrepancy or complete consistency. The relationship between consistency and age, sex, average length of stay in the hospital and study period was analyzed. The 91 autopsies were performed on 64 men and 27 women. The mean age was 63 years and the average length of study in the hospital was 9.7 days. The global consistency was 71.4%. In 15 (16.5%) cases, a major discrepancy was observed and in 11 (12.1%), a minor discrepancy. No differences were observed in the degree of consistency with respect to age, sex, average length of stay and study period. Cardiovascular diseases showed the greatest proportion of major discrepancies at the expense of three cases of pulmonary thromboembolism. We conclude that the degree of concordance in this study is consistent with other studies and we discuss the relevance of clinical autopsies regarding several aspects of health care.
在过去几年中，医院临床尸检的数量显著减少，该程序的一些功能面临丧失的风险，其中作为医疗质量指标的诊断准确性评估尤为突出。本文研究了一家综合医院临床诊断与尸检之间的一致性，以及其与一些潜在相关因素的关联。我们回顾了内科服务部门在六年期间对91例死亡患者进行的尸检。通过临床医生和病理学家的共识，将每个病例分类为：主要临床病理差异、轻微差异或完全一致。分析了一致性与年龄、性别、平均住院时间和研究期间的关系。91例尸检对象为64名男性和27名女性。平均年龄为63岁，平均住院研究时间为9.7天。总体一致性为71.4%。在15例（16.5%）病例中观察到主要差异，11例（12.1%）为轻微差异。在一致性程度方面，未观察到年龄、性别、平均住院时间和研究期间的差异。心血管疾病的主要差异比例最大，其中有三例是肺血栓栓塞。我们得出结论，本研究中的一致性程度与其他研究一致，并且我们讨论了临床尸检在医疗保健几个方面的相关性。
